Provider Demographics
NPI:1790049369
Name:CHEN, JIWEI (PA)
Entity Type:Individual
Prefix:MR
First Name:JIWEI
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:MR
Other - First Name:JIWEI
Other - Middle Name:
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:2331 FRANKLIN RD SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1111
Mailing Address - Country:US
Mailing Address - Phone:540-725-1226
Mailing Address - Fax:540-857-5306
Practice Address - Street 1:2331 FRANKLIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1111
Practice Address - Country:US
Practice Address - Phone:540-725-1226
Practice Address - Fax:540-857-5306
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
VA0110004912363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1790049369OtherANTHEM MEDIGAP
VA540506332199OtherTRICARE
VA1790049369OtherCCC VIRGINIA PREMIER
VA1790049369OtherINTOTAL
VA1790049369OtherUMWA
VA1790049369OtherAETNA
VA1790049369OtherOPTIMA HEALTHCARE
VA1790049369OtherMEDICAID QMB
VAP01642937OtherRAILROAD MEDICARE
VA1790049369OtherHUMANA MEDICARE
VA1790049369OtherSOUTHERN HEALTH/CARENET/CARELINK/COVENTRY
VA1790049369OtherUMWA